A journal dedicated to allied health professional practice and education
http://ijahsp.nova.edu      Vol. 3 No. 1    ISSN 1540-580X 

A Peer Reviewed Publication of the College of Allied Health & Nursing at Nova Southeastern University

Correspondence:
 

Brian J. Hughes, EdD, ATC/R
Central Missouri State University
Morrow Hall 102C
Warrensburg, Missouri 64093
(660) 543-8062 office
(660) 543-8847 fax
bhughes@cmsu1.cmsu.edu
 

Citation:
Hughes, B. Identifying attitudes and deterring factors towards continuing education among certified athletic trainers. The Internet Journal of Allied Health Sciences and Practice. January 2005. Volume 3 Number 1.

Introduction

Today, almost all professionals find it necessary and often times mandatory to participate in continuing professional education. Professionals seek to enroll in programs that go beyond their original degree status in order to preserve current knowledge and skill, maintain current certification and gain advanced knowledge and skill to grow professionally. For almost the first 50 years of the last century, society has come to accept the notion that members of professions must maintain competence and the quality of essential services being provided to them.¹ This was evident in 1970 for the field of athletic training when the National Athletic Trainers Association (NATA) established the first national certification examination administered by the NATA Certification Committee.² Also at that same, several states began to require professional medical licensure for certified athletic trainers (ATCs). These same societal sentiments persist today. Because of litigation and legislative acts the development of continuing professional education demonstrates how societal pressures can create responses related to professional fields.² As a direct result, many professions including athletic training, are seeking to increase their knowledge base and adapt to these changing sentiments. Therefore, practitioners must turn to continuing professional education as their main avenue towards professional competence.

The profession of athletic training has recently had a number of studies dedicated to continuing professional education and its affects on the membership. For example, Cuppett attempted to discover the continuing education needs of certified athletic trainers (ATCs) using the National Athletic Trainers Association (NATA) Role Delineation Study 3^rd ed.³ In an attempt to show how adult education theories can be used to improve the delivery of continuing professional education to ATCs, Pitney outlined a new model on how continuing professional education can be reconstructed to fit the learning needs of practicing ATCs.⁴  Finally, Draper and Young investigated how learning styles can be linked to continuing professional education strategies in continuing education seminars for ATCs.⁵  While the continuing education needs, learning styles, and perceptions of continuing education of ATCs have been investigated, there is to date no understanding of ATCs’ perceived attitudes of continuing education, or the factors that may deter their participation in continuing education.^3,5,6 As a profession, athletic training should also pay attention to how these attitudes and deterrents affect an individual’s perception of continuing professional education. Therefore, the purpose of this study was to identify the perceived attitudes and deterring factors toward continuing professional education for ATCs.

Attitudes

To gain further insight on how professionals perceive and interpret the need and importance of continuing professional education, an examination of attitudes toward continuing professional education must be examined. In one of the first studies on the attitudes towards continuing professional education, Houle conducted research on what motivates adults to learn more information on the world around them.⁷ In his research, Houle discovered that there were three basic types of adult learners: 1) goal-oriented learners, 2) activity-oriented learners, 3) and learning-oriented learners.⁷ Goal-oriented learners use education as a means of achieving some other goal; activity-oriented learners participate for the sake of the activity itself and the social interaction; and learning-oriented participants seek knowledge for its own sake.

Additional studies have built upon Houle’s original idea of motivating factors in adult education. Shortly after Houle’s model was developed, Sheffield developed an instrument to measure an adult’s learning orientation.⁸ From his factor analysis; Sheffield surmised that there was a possibility of five orientations. Other research models and measures were soon developed in support of why adult choose to attain more education.^9-11 Between these different models, the original works of Houle was greatly expanded to included the possibility of a seven-factor typography of adult learning orientation

Related specifically to professional development and continuing professional education, Cervero explained possible reasons why professionals choose to attain more education.¹² According to Cervero, there are five major reasons why professionals participate in continuing education.¹² These reasons include 1) maintaining current abilities; 2) increasing the likelihood that their clients will be better served; 3) being prepared to be challenged by colleagues; 4) maintaining identity in the profession; and 5) enhancing one’s individual security in their present profession. In addition, the research suggests that the reasons for participation can differ significantly according to the type of profession, career stage in that profession, type of practice setting, and number of years in that profession.¹² For the field of athletic training these principles can have significant positive ramifications on the facilitation, planning, and the implementation of continuing professional education.

Deterrents

Conversely to attitudes in continuing professional education, deterring factors are characteristics that help to explain why adults respond in a negative manner to attaining more education. When investigating the reasons why adult choose not to gain more education, it becomes important to investigate what obstacles or deterrents they encounter in this process. In one of the first studies on the deterrents to adult education, Johnstone and Rivera found that adults might face many different types of barriers when they want to pursue more education.¹³ In their first study, almost one-half of the respondents failed to participate in education for financial reasons. Following closely behind financial considerations were time constraints and family responsibilities.¹³ Potential deterrents were later broken down into two major categories; external deterrents and internal deterrents. External deterrents are seen as influences beyond the individual’s own control and internal barriers were characteristics that reflected personal attitudes on why adults did not want participate in educational endeavors.¹⁴

Expanding beyond these earlier works, Cross discovered that there were other types of deterrents that adults can encounter in continuing education.¹⁵ These obstacles include situational, institutional, and dispositional deterrents. Situational deterrents can be described as deterrents at a given time in one’s life. Examples might include responsibilities to work or family may inhibit one from further education while lack of money, time, or resources may preclude others from their educational dreams. Institutional deterrents are practices of the institution that inhibit participation in adult learning activities. These deterrents may include inconvenient scheduling of classes, excessive time requirements for the degree, and difficulty even enrolling in courses. Dispositional deterrents occur when the learner’s own attitudes and self-perception inhibit their educational attainment. Feeling that they are too old to learn or that they were a poor student in the past can lead an adult to believe that further education is not for them.¹⁵ Though continuing education is a mandatory act for ATCs as mandated by the National Athletic Trainers Association Board of Certification (NATABOC), there is less understanding on why these practitioners choose or choose not to participate in continuing education activities.

With the profession of athletic training becoming more diverse in its membership and in work setting, it should become imperative that ATCs become better aquatinted with the processes that either help or hinder their learning needs and expectations. As mentioned before, ATCs have different reasons for attaining more education in their professional careers. But to know exactly why they choose to attain more education or what motivates them, a close examination of their attitudes must be performed. As previously outlined, deterrents can have a detrimental and negative consequence on the professional practice of an ATC. However, it should be pointed out those deterrents not only affect ATCs, but more importantly, they can directly impact the healthcare delivery to the patients that they care for. Therefore, the purpose of this study was to identify the attitudes toward and deterring factors in continuing education for certified athletic trainers.

Methods

Subjects

The data for this descriptive study was gathered from ATCs using the listserv at Indiana State University and the professional athletic trainers education listserv at Findlay University. A human subjects form was submitted and approved for this study by the appropriate institutional human subjects review board. A request to participate in this study was emailed to the listserv members with a combined total of 2,500 members in which 1,200 were ATCs. Responses were received from 268 certified athletic trainers. This sample size is slightly under the recommended sample size of 291 for a 95% confidence level that the sample is representative of the population.

Although the profile of the respondents was somewhat different from that of the NATA, it was similar in several key areas (see Table 1).¹⁶  The NATA reports that male ATCs account for 56% of their membership while females account for 44% of the membership.¹⁶ For the racial profile of the respondents in this study, a disproportionately high percentage were whites (94.42%) (see Table 1). Other groups represented in this study included Asians (.40%), Hispanics (2.39%), African American (1.59%), Native American (.40%), and other (.80%).¹⁶ These findings highlight a representative sample of the general population of certified athletic trainers as reported by the NATA where whites accounted for 86% of its certified athletic trainer population while Asians accounted for 2%, Hispanics 2%, African Americans 1%, Native Americans 1%, and other 1%.¹⁶

Certified athletic trainers are employed in diverse work setting. Of the 258 respondents in this area, nearly three-quarters (73.15%) reported to be employed at the college setting where as the NATA reports that only one-fifth (21%) of all certified athletic trainers work at the college setting (see Table 1). As for the remainder of settings, 12.84% reported to be employed at the high school setting while the NATA reports that over one-third (34%) of certified athletic trainers work in this setting. In the clinical/hospital setting, only 7% of the respondents reported to be employed in this setting while the NATA reports over one-third (34%) of its members are employed in that particular setting. For the professional setting, 1.56% of the responses reported to work in this setting, whereas almost 10% of all certified athletic trainers work in that setting. For the industrial setting, the NATA reports that 1% of its members work at this setting with 1.17% of this study claiming to work in the industrial setting. For the remainder of this population, 4.28% reported being employed at other settings.¹⁶  Thus, the population for this study had a disproportionately high number of respondents from the college setting and an equally disproportionate low number of respondents from the high school and clinical/hospital settings.

The entry-level degree for a certified athletic trainer is the bachelor’s degree. Of the 258 respondents in this area, just under two-thirds (63.53%) report having a master’s degree, one-fifth (19.61%) have a bachelor’s degree, and 16.86% have a doctorate (see Table 1). Similar to these findings, the NATA reported in 2000 that just over one-half (54%) of 1,000 randomly sampled ATCs held a master’s degree. The remainder held a bachelor’s degree (32%), a doctorate (6%), and other (8%).¹⁶  Thus the sample for this study was slightly more formally educated than the general population of certified athletic trainers.

In the field of athletic training, certified athletic trainers can reach their certification from two different education routes. Certification can be attained from an internship model or from a curriculum model. Almost three-fifths (57.48%) came from an internship model while a little over two-fifths (42.52%) came from a curriculum model (see Table 1). Currently, the NATA does not keep records on the route a current ATC has taken to their certification.

Table 1.
Frequency of Demographic Variables

Design

This was a descriptive study that used the Adult Attitudes Toward Continuing Education Scale (AATCES) instrument, the Deterrents to Participation Scale-General (DPS-G) instrument, and a demographic form to gather data. Both the AATCES and the DPS-G are valid and reliable instruments. Demographic data were collected on experience level, race, age, route to certification, and continuing education meetings attended per year (see Table 1).

The AATCES is a 22-item scale that uses a 5-point Likert scale, which ranges from Strongly Disagree to Strongly Agree, to detect perceived attitudes on continuing education. The construct validity for the AATCES was established through constructing items based a literature review and by having an expert adult education panel review these items. Construct validity was then inferred from this process.¹⁸  The AATCES has a Cronbach reliability coefficient of .90 in its final form.¹⁹

The DPS-G is 34-item survey that uses a 5-point Likert scale, which ranges from Not Important to Very Important, to measure deterrents to participation in continuing education. Items for the instrument were constructed by interviewing and randomly sampling a diverse group of adults with varying educational backgrounds and economic status. These items were “subjected to standard item analysis procedures” to select the items for final form of the instrument, and a factor analysis revealed that these items formed six separate factors.²⁰  The content validity for the DPS-G was further established through an elaborate interview process on each item while construct validity was also established using a correlation analysis between selected variables and six deterrent variables.²⁰ The internal reliability for the DPS-G is .86.¹⁹

Several statistical procedures were used to analyze the data. Descriptive statistics were used to construct a profile of the ATCs on the demographic variables and on the scores on the instruments. Analysis of variance was used to investigate the relationship between selected demographic variables and the AACTES and the DPS-G. Cluster analysis was used to explore for natural groups among the ATCs based on their attitudes toward and deterrents to participation in continuing education.

Results
 

The results of this study indicate that as a whole, professionals in the field of athletic training have a very favorable attitude towards continuing professional education. In fact, this can be clearly seen in how the respondents scored on the AATCES instrument. The overall mean score on the AATCES was 91 with a standard deviation of 8.25 (see Table 2); thus representing an average response of 4.1 on the 5-point scale and is just above the rating of Agree. Although the instrument has a scoring range between 22 and 110, the range for certified athletic trainers was between 66 and 110. By scoring a 4.1 on the AATCES instrument, the responding ATCs saw continuing professional education as an important function in their professional livelihood. In addition to the overall high scores on the AATCES instrument, no differences were found in the comparison of the different demographic variables to attitudes. The absence of differences among the variables indicates that this favorable attitude toward continuing professional education is generally held throughout this population regardless of self-reported demographic information.

Table 2
Frequency of AATCES Scores Divided into Quartiles

The results of this study indicate that professionals in the field of athletic training have few deterrents towards continuing professional education in their professional lives. The group’s mean on the DPS-G was 80.39 with a standard deviation of 19.28 (see Table 3). The mean of 80.49 represents an average response of 2.36 on the 5-point scale and is near the rating of Slightly Important. The DPS-G has a possible scoring range of 34-170. The respondents’ scores ranged from 34-143 with the most frequently occurring score of 65. The field of athletic training is divided nearly equally between males and females, and the sample for this study reflected this distribution. Therefore, the participants were grouped as males and females and compared to the factors of the DPS-G. Overall females (91.64%) had a more positive attitude than males (89.11%) on the DPS-G. In addition, significant differences were also found with items related to Cost (F = 8.46, df = 1/254, p = .004) and Time (F = 7.05, df = 1/254, p = .008) when compared to gender differences. The female respondents viewed “Cost” as a greater deterrent than did males, and females also felt that “Time” was a greater deterrent than did the male respondents.

Table 3.
Frequency of DPS-G Scores Divided into Quartiles

A cluster analysis was conducted using the items from the AACTES and the DPS-G. This statistical procedure used these items to find inherent groups among the certified athletic trainers. Three groups were found, and the process that separated them was Lack of Course Relevance. The “eager-beaver” group of 61 was younger, less experienced, and attended less continuing professional meetings per year than the others, and course relevance was of low importance to them. The “cautiously-eager” group of 93 was slightly older and more experienced than the “eager-beaver” group, and course relevance played a greater role in their selection of courses at meetings. The “mellow” group of 98 was the oldest and most experienced of the three groups, and course relevancy was a greater concern for them.

Overall, these findings indicate that this population did not view many deterrents to continuing professional education in their professional lives. However, Lack of Course Relevance, Time, and Cost were seen as important to ATCs and were observed as one of the few possible deterrents to continuing professional education.

Discussion

Many healthcare providers have come to see the importance of continuing professional education not only for a practitioner’s knowledge base but also for the improved delivery of patient care.^19,20 In addition, some have seen that fundamental changes in continuing professional education are needed to meet these societal demands.²¹ Many professions seeking to increase their knowledge base and adapt to societal pressures have turned to continuing professional education as their main avenue towards proficiency. Continuing professional education must also take into account both the profession itself and its role within society.²²  Because society is becoming increasingly knowledgeable and up-to-date on standards in professional practices, professions must now seek continuing education to adhere to society’s performance standards and accountability.²

To underscore just how important continuing professional education can be for the profession of athletic training, an examination must be made at why professionals continue this practice. Since ATCs are frequently responsible for the daily healthcare of the physically active, the profession needs to see in plain text why they must continuously evolve and refine their skills. The goal for continuing professional education in athletic training hould be one that will convey a complex attitude made up of the readiness to use the current best practice. Professionals must also expect that these techniques will be modified or replaced in time. From this description of continuing professional education for ATCs, the intent must be purposeful, imply some form of learning that advances from a previously established level of accomplishment, to extend and amplify knowledge, sensitiveness, or skill.¹

As individuals mature and develop in their professional setting, many changes may occur not only in title and stature but also in their acquisition of knowledge. In the ever-increasing need for mature and competent professionals, there is a tremendous demand for adult learners who have the ability to apply their experiential knowledge. Along with their personal experiential knowledge, the adult learner within the profession today can greatly benefit from the andragogical learning method. This learning model for adult learners is instrumental in understanding just how important continuing professional education is to a professional and how new knowledge can be applied directly in one’s career. According to Knowles, the andragogical model consists of six distinct steps.^23,24  These steps include: 1) the learner’s self-concept moves toward one of being self-directed 2) the professionals accumulate a growing reservoir of experience that becomes an increasing resource for learning 3) a readiness to learn becomes oriented increasingly to the development task of social skills 4) their time perspective changes to immediate application of knowledge and to one of performance-centeredness 5) the motivation to learn becomes internal and 6) adults need to know why they need to learn something before undertaking the task of learning. There has been suggested that within athletic training, the andragogical method has the potential to not only impact the delivery of continuing professional education but also to improve the practitioner effectiveness in the delivery of healthcare. ^4,5

A critical component of adult education includes the actual study of continuing professional education itself. Continuing professional education, according to Houle, helps to explain the need for constant learning as it directly relates to the complex nature of the professional in the ever-changing job market.¹ Acknowledging that the job market has been changing and that many people do not fit the regular patterns of pre-service training or development, professional competence needs to be reformulated and restructured to adjust to these recent trends. Recognizing this tendency, continuing professional education now more than ever has the ability to assist professionals in their acquisition of new knowledge.

Limitations

A request to participate in this study was emailed to the listserv members with a combined total of 2,500 members in which 1,200 were ATCs. Responses were received from 268 certified athletic trainers. This sample size is slightly under the recommended sample size of 291 for a 95% confidence level that the sample is representative of the population.

Conclusions

The first avenue of inquiry in this study examined how ATCs perceived attitudes toward continuing professional education using the AATCES instrument. In this study, it was found that ATCs have a strong willingness to attain new education and continue a proficient level of professional competence. This strong positive attitude toward continuing professional education allows ATCs to grow not only in their practice but also as better professionals in their delivery of healthcare. A second inquiry was made in this study of how ATCs perceived deterrents to continuing professional education. These perceived deterrents were examined using the DPS-G instrument. From these analyses, few differences were found. In areas where deterrents did appear, the deterrents tended to be the situational variables of Cost, Time, and Course Relevance.

To maintain good standing within the profession, ATCs must maintain a certain level of competence through continuing education units. From this study, ATCs feel that even though continuing professional education is a mandatory part of their practice, they still had a very high positive attitude towards it. The ATCs answering the questionnaire responded as though continuing professional education was intertwined into the fabric of the profession. Since ATCs are vital health care providers for the active population, the nature of the profession is one that cannot stand still in discovering new techniques and technologies in the provision of continuing professional education.        

One method that the profession of athletic training can use to ensure excellent delivery of continuing education is through proper program planning at conventions and seminars. For those who cited Lack of Course Relevance as a possible deterrent to continuing professional education, practical program planning can have a far-reaching effect on the acquisition and retention of material. As an integral component of continuing education, program planning can have a far-reaching impact not only on course content but more importantly on the delivery and retainment of the course content. Since continuing education seminars can be quite diverse in content, these meetings must therefore include a wide range of activities that give people the kinds of learning experiences they really want.¹ Therefore, since each member comes to these seminars to learn about different topics, program planning must be thought of as a key component on delivering the necessary information through multiple mediums.

Aside from on-sight program planning, practical changes in continuing education units for the field should also be made for those who identified Cost and Time as deterrents. To make the continuing education experience meaningful for more ATCs, greater considerations should be made for those members who have limited continuing education money and for those who have greater life commitments. More continuing education credits can be placed on home-study projects, journal reviews, collegial study groups, and on-line examinations.

References

1. Houle CO. Continuing Education in the Professions. San Francisco, Ca: Jossey-Bass. 1980:150-152.
    

2. Delforge GD &  Behnke RS. The history and evolution of athletic training education in the United States. J Athl Train. 1991;34:53-61.
    

3. Knox AB. Strengthening Adult and Continuing Education: A Global Perspective on Synergistic Leadership. San Francisco, CA: Jossey-Bass. 1993:275-288.
    

4. Cuppett MM. Self-perceived continuing education needs of certified athletic trainers. J Athl Train. 2001;36:388-395.
    

5. Pitney WA. Continuing education in athletic training: An alternative approach based on adult learning theory. J Athl Train. 1998;33:72-76.
    

6. Draper DO & Young W. Continuing education for athletic trainers based on learning styles research. J Contin Educ in the Health Prof. 1989;9:193-97.
    

7. Weidner, T.G. Athletic training continuing education needs assessment: pilot study. J Athl Train. 1994;29:67-69.
    

8. Houle CO. The Inquiring Mind. Madison, WI: University of Wisconsin Press. 1961:17-24.
    

9. Sheffield SB. The Orientation of Adult Continuing Learners [dissertation]. Chicago, IL: University of Chicago; 1962.
    

10. Burgess P. Reasons for adult participation in group educational activities. Adult Educ Q.1971;22:3-29.
     

11. Boshier R. Motivational orientations of adult education participants: a factor analytical exploration of Houle’s typology. Adult Educ Q. 1971;21:3-26.
     

12. Morstain BR, Smart JC. Reasons for participation in adult education courses: a multivariate analysis of group differences. Adult Educ Q. 1974;24:83-98.
     

13. Cervero RM. Effective Continuing Education for Professionals. San Francisco, CA: Jossey-Bass. 1988:42-65.
     

14. Johnstone JW, Rivera, RJ. Volunteers for Learning. Chicago, IL: Aldine. 1965.
     

15. Merriam SB, Caffarella RS. Learning in Adulthood: A Comprehensive Guide. San Francisco, CA: Jossey-Bass. 1999.
     

16. National Athletic Trainers Association Website. http://www.nata.org.
     

17. Cross KP. Adults as Learners: Increasing Participation and Facilitating Learning. San Francisco, CA: Jossey-Bass. 1981:101-107.
     

18. Darkenwald GG, Hayes ER. Assessment of adult attitudes toward continuing education. Inter J Lifelong Learn.1988;7:130-133.
     

19. Erikson CG. Influence of Barriers to Participation and Attitudes Toward Adult Education on Small Business Managers’ Participation in Adult Education. [dissertation]. Bozeman, MT: Montana State University; 1990.
     

20. Darkenwald GG, Valentine T. Factor structure of deterrents to public participation in adult education. Adult Educ Q. 1985;35:117-193.

21. Holm HA, Continuing Medical Education. Br Med J. 1998;316:621-624.
     

22. Sectich TC, Floriani V, Bernstein HH, Badat MC, Perelman R. Continuing professional development: raising the bar for Pediatricians. Pediatrics. 2002;110:155-157.
     

23. Knowles MS. The Modern Practice of Adult Education: Andragogy Versus Pedagogy. Chicago, IL: Follett. 1970:44-58.
     

24. Knowles MS, Holton, EF, Swanson RA. The Adult Learner. The Definitive Classic in Adult Education and Human Resource Development. 5th ed. Chicago, IL: Follett. 1998:64-68.

Appendix A: Demographic Information

Gender: _____ Male    _____ Female

Your age: _____

Education:

How many years experience do you have as a certified athletic trainer? _____

Please select your highest level of formal education.

            Bachelors Degree _____

            Masters Degree _____

            Doctorate _____

How many continuing professional education meetings a year do you attend? _____

How much money is allocated to you per year of continuing professional education? _____

Employment setting:

            Clinic/hospital _____

            College _____

            High School _____

            Industrial _____

            Professional_____

Race:

            African American _____

            Asian _____

            Hispanic _____

            Native American _____

            White _____

            Other _____

Appendix B.
Attitudes to Continuing Education Scale (AATCES)

SD = Strongly Disagree   D = Disagree   U = Undecided   A = Agree   A = Strongly Agree

Appendix C.
Deterrents to Participation Scale-General  (DPS-G)

NI = Not Important  SI = Slightly Important  I = Somewhat Important  QI = Quite Important  VI = Very Important

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